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the coronavirus more often infects clusters of family members, friends and work colleagues,

“You can contain clusters,” Dr. Heymann said. “You need to identify and stop discrete outbreaks, and then do rigorous contact tracing.”

The microphone should not even be at the White House, scientists said, so that briefings of historic importance do not dissolve into angry, politically charged exchanges with the press corps, as happened again on Friday.

Americans must be persuaded to stay home, they said, and a system put in place to isolate the infected and care for them outside the home

Travel restrictions should be extended, they said; productions of masks and ventilators must be accelerated, and testing problems must be resolved.

It was not at all clear that a nation so fundamentally committed to individual liberty and distrustful of government could learn to adapt to many of these measures, especially those that smack of state compulsion.

What follows are the recommendations offered by the experts interviewed by The Times.

they were united in the opinion that politicians must step aside and let scientists both lead the effort to contain the virus and explain to Americans what must be done.

medical experts should be at the microphone now to explain complex ideas like epidemic curves, social distancing and off-label use of drugs.

doing so takes intelligent, rapidly adaptive work by health officials, and near-total cooperation from the populace. Containment becomes realistic only when Americans realize that working together is the only way to protect themselves and their loved ones.

Above all, the experts said, briefings should focus on saving lives and making sure that average wage earners survive the coming hard times — not on the stock market, the tourism industry or the president’s health.

“At this point in the emergency, there’s little merit in spending time on what we should have done or who’s at fault,”

The next priority, experts said, is extreme social distancing.If it were possible to wave a magic wand and make all Americans freeze in place for 14 days while sitting six feet apart, epidemiologists say, the whole epidemic would sputter to a halt.

The virus would die out on every contaminated surface and, because almost everyone shows symptoms within two weeks, it would be evident who was infected. If we had enough tests for every American, even the completely asymptomatic cases could be found and isolated.

The crisis would be over.

Obviously, there is no magic wand, and no 300 million tests. But the goal of lockdowns and social distancing is to approximate such a total freeze.

In contrast to the halting steps taken here, China shut down Wuhan — the epicenter of the nation’s outbreak — and restricted movement in much of the country on Jan. 23, when the country had a mere 500 cases and 17 deaths.Its rapid action had an important effect: With the virus mostly isolated in one province, the rest of China was able to save Wuhan.

Even as many cities fought their own smaller outbreaks, they sent 40,000 medical workers into Wuhan, roughly doubling its medical force.

Stop transmission within cities

the weaker the freeze, the more people die in overburdened hospitals — and the longer it ultimately takes for the economy to restart.

People in lockdown adapt. In Wuhan, apartment complexes submit group orders for food, medicine, diapers and other essentials. Shipments are assembled at grocery warehouses or government pantries and dropped off. In Italy, trapped neighbors serenade one another.

Each day’s delay in stopping human contact, experts said, creates more hot spots, none of which can be identified until about a week later, when the people infected there start falling ill.

South Korea avoided locking down any city, but only by moving early and with extraordinary speed. In January, the country had four companies making tests, and as of March 9 had tested 210,000 citizens — the equivalent of testing 2.3 million Americans.

As of the same date, fewer than 9,000 Americans had been tested.

Fix the testing mess

Testing must be done in a coordinated and safe way, experts said. The seriously ill must go first, and the testers must be protected.In China, those seeking a test must describe their symptoms on a telemedicine website. If a nurse decides a test is warranted, they are directed to one of dozens of “fever clinics” set up far from all other patients.

Isolate the infected

As soon as possible, experts said, the United States must develop an alternative to the practice of isolating infected people at home, as it endangers families. In China, 75 to 80 percent of all transmission occurred in family clusters.

Cellphone videos from China show police officers knocking on doors and taking temperatures. In some, people who resist are dragged away by force. The city of Ningbo offered bounties of $1,400 to anyone who turned in a coronavirus sufferer.

In China, said Dr. Bruce Aylward, leader of the World Health Organization’s observer team there, people originally resisted leaving home or seeing their children go into isolation centers with no visiting rights — just as Americans no doubt would.

In China, they came to accept it.“They realized they were keeping their families safe,” he said. “Also, isolation is really lonely. It’s psychologically difficult. Here, they were all together with other people in the same boat. They supported each other.”

Find the fevers

Make masks ubiquitous

In China, having a fever means a mandatory trip to a fever clinic to check for coronavirus. In the Wuhan area, different cities took different approaches.

In most cities in affected Asian countries, it is commonplace before entering any bus, train or subway station, office building, theater or even a restaurant to get a temperature check. Washing your hands in chlorinated water is often also required.

The city of Qianjiang, by contrast, offered the same amount of money to any resident who came in voluntarily and tested positive

Voluntary approaches, like explaining to patients that they will be keeping family and friends safe, are more likely to work in the West, she added.

Trace the contacts

Finding and testing all the contacts of every positive case is essential, experts said. At the peak of its epidemic, Wuhan had 18,000 people tracking down individuals who had come in contact with the infected.

Dr. Borio suggested that young Americans could use their social networks to “do their own contact tracing.” Social media also is used in Asia, but in different ways

When he lectured at a Singapore university, Dr. Heymann said, dozens of students were in the room. But just before he began class, they were photographed to record where everyone sat.

Instead of a policy that advises the infected to remain at home, as the Centers for Disease and Prevention now does, experts said cities should establish facilities where the mildly and moderately ill can recuperate under the care and observation of nurses.

There is very little data showing that flat surgical masks protect healthy individuals from disease. Nonetheless, Asian countries generally make it mandatory that people wear them.

The Asian approach is less about data than it is about crowd psychology, experts explained.All experts agree that the sick must wear masks to keep in their coughs. But if a mask indicates that the wearer is sick, many people will be reluctant to wear one. If everyone is required to wear masks, the sick automatically have one on and there is no stigma attached.

Also, experts emphasized, Americans should be taught to take seriously admonitions to stop shaking hands and hugging

Preserve vital services

Only the federal government can enforce interstate commerce laws to ensure that food, water, electricity, gas, phone lines and other basic needs keep flowing across state lines to cities and suburbs

“I sense that most people — and certainly those in business — get it. They would prefer to take the bitter medicine at once and contain outbreaks as they start rather than gamble with uncertainty.”

Produce ventilators and oxygen

The manufacturers, including a dozen in the United States, say there is no easy way to ramp up production quickly. But it is possible other manufacturers, including aerospace and automobile companies, could be enlisted to do so.

Canadian nurses are disseminating a 2006 paper describing how one ventilator can be modified to treat four patients simultaneously. Inventors have proposed combining C-PAP machines, which many apnea sufferers own, and oxygen tanks to improvise a ventilator.

One of the lessons of China, he noted, was that many Covid-19 patients who would normally have been intubated and on ventilators managed to survive with oxygen alone.

Retrofit hospitals

In Wuhan, the Chinese government famously built two new hospitals in two weeks. All other hospitals were divided: 48 were designated to handle 10,000 serious or critical coronavirus patients, while others were restricted to handling emergencies like heart attacks and births.

Wherever that was impractical, hospitals were divided into “clean” and “dirty” zones, and the medical teams did not cross over. Walls to isolate whole wards were built

Decide when to close schools

Recruit volunteers

China’s effort succeeded, experts said, in part because of hundreds of thousands of volunteers. The government declared a “people’s war” and rolled out a “Fight On, Wuhan! Fight On, China!” campaign.

Many people idled by the lockdowns stepped up to act as fever checkers, contact tracers, hospital construction workers, food deliverers, even babysitters for the children of first responders, or as crematory workers.

“In my experience, success is dependent on how much the public is informed and participates,” Admiral Ziemer said. “This truly is an ‘all hands on deck’ situation.”

Prioritize the treatments

Clinicians in China, Italy and France have thrown virtually everything they had in hospital pharmacies into the fight, and at least two possibilities have emerged that might save patients: the anti-malaria drugs chloroquine and hydroxychloroquine, and the antiviral remdesivir, which has no licensed use.

An alternative is to harvest protective antibodies from the blood of people who have survived the illness,

The purified blood serum — called immunoglobulin — could possibly be used in small amounts to protect emergency medical workers, too.

“Unfortunately, the first wave won’t benefit from this,” Dr. Hotez said. “We need to wait until we have enough survivors.”Find a vaccine

testing those candidate vaccines for safety and effectiveness takes time.

The roadblock, vaccine experts explained, is not bureaucratic. It is that the human immune system takes weeks to produce antibodies, and some dangerous side effects can take weeks to appear.

After extensive animal testing, vaccines are normally given to about 50 healthy human volunteers to see if they cause any unexpected side effects and to measure what dose produces enough antibodies to be considered protective.

If that goes well, the trial enrolls hundreds or thousands of volunteers in an area where the virus is circulating. Half get the vaccine, the rest do not — and the investigators wait. If the vaccinated half do not get the disease, the green light for production is finally given.

In the past, some experimental vaccines have produced serious side effects, like Guillain-Barre syndrome, which can paralyze and kill. A greater danger, experts said, is that some experimental vaccines, paradoxically, cause “immune enhancement,” meaning they make it more likely, not less, that recipients will get a disease. That would be a disaster.

One candidate coronavirus vaccine Dr. Hotez invented 10 years ago in the wake of SARS, he said, had to be abandoned when it appeared to make mice more likely to die from pneumonia when they were experimentally infected with the virus.

Reach out to other nations

“But that’s not the only damage the United States will suffer. Far from ‘making America great again’, this epic policy failure will further tarnish [its] reputation as a country that knows how to do things effectively.”

This adverse shift could be permanent, Walt warned. Since taking office in 2017, Trump has insulted America’s friends, undermined multilateral alliances and chosen confrontation over cooperation. Sanctions, embargoes and boycotts aimed at China, Iran and Europe have been globally divisive.

Trump’s ineptitude and dishonesty in handling the pandemic, which has left foreign observers as well as Americans gasping in disbelief, is proving a bridge too far.

Erratic behaviour, tolerated in the past, is now seen as downright dangerous. It’s long been plain, at least to many in Europe, that Trump could not be trusted. Now he is seen as a threat. It is not just about failed leadership. It’s about openly hostile, reckless actions.

The furious reaction in Germany after 200,000 protective masks destined for Berlin mysteriously went missing in Thailand and were allegedly redirected to the US is a case in point. There is no solid proof Trump approved the heist. But it’s the sort of thing he would do – or so people believe.

“We consider this to be an act of modern piracy. This is no way to treat transatlantic partners. Even in times of global crisis, we shouldn’t resort to the tactics of the wild west,” said Andreas Geisel, a leading Berlin politician. Significantly, Merkel has refused to give Trump the benefit of the doubt.

While publicly rejecting foreign help, Trump has privately asked European and Asian allies for aid – even those, such as South Korea, that he previously berated.

There was dismay among the G7 countries that a joint statement on tackling the pandemic could not be agreed because Trump insisted on calling it the “Wuhan virus” – his crude way of pinning sole blame on China.

Trump has ignored impassioned calls to create a Covid-19 global taskforce or coalition. He appears oblivious to the catastrophe bearing down on millions of people in the developing world.

“Trump’s battle against multilateralism has made it so that even formats like the G7 are no longer working,” commented Christoph Schult in Der Spiegel. “It appears the coronavirus is destroying the last vestiges of a world order.”

Trump’s surreal televised Covid-19 briefings are further undermining respect for US leadership. Trump regularly propagates false or misleading information, bets on hunches, argues with reporters and contradicts scientific and medical experts.

Europeans were already outraged by Trump’s reported efforts to acquire monopoly rights to a coronavirus vaccine under development in Germany. This latest example of nationalistic self-interest compounded anger across the EU over Trump’s travel ban, imposed last month without consultation or scientific justification.

To a watching world, the absence of a fair, affordable US healthcare system, the cut-throat contest between American states for scarce medical supplies, the disproportionate death toll among ethnic minorities, chaotic social distancing rules, and a lack of centralised coordination are reminiscent of a poor, developing country, not the most powerful, influential nation on earth.

That’s a title the US appears on course to lose – a fall from grace that may prove irreversible. The domestic debacle unleashed by the pandemic, and global perceptions of American selfishness and incompetence, could change everything. According to Walt, Trump has presided over “a failure of character unparalleled in US history”.

Do Americans realise how far their country’s moral as well as financial stock has fallen? Perhaps at this time of extreme stress, it seems not to matter. But it will matter later on – for them and for the future international balance of power.

Heiko Maas, Germany’s foreign minister, said he hoped the crisis would force a fundamental US rethink about “whether the ‘America first’ model really works”. The Trump administration’s response had been too slow, he said. “Hollowing out international connections comes at a high price,” Maas warned.

Two vaccines have been approved by the FDA and are now being distributed in the U.S.

Hospitals are overwhelmed. Nurses are overworked. And the state's overall cases make up more than 10% of the nation's.

President-elect Joe Biden vowed on Tuesday that the U.S. would pick up the pace during a speech detailing his plans.

"We need to be honest: The next few weeks and months are going to be very tough, a very tough period for our nation — maybe the toughest during this entire pandemic," Biden said. "I know it's hard to hear, but it's the truth."

The Post reports that Trump propagandists like Sean Hannity have stampeded in herd-like fashion from initially attacking the media for supposedly hyping coronavirus to claiming its dire nature actually displays Trump’s heroism.

First Trump and his propagandists falsely accused the media of exaggerating the threat to protect his initial instinct to downplay it himself, all to avoid rattling the markets, to buoy his reelection hopes.

when it became obvious the crisis was very serious indeed, Trump attacked the media to falsely discredit its aggressive reporting on his failure to respond to it competently and with urgency. And now, Trump’s propagandists are supplanting that accurate reporting with their own narrative — one in which the very same crisis they previously downplayed now showcases Trump’s decisive and “bold” leadership.

another report, from the New York Times, ferrets out alarming new behind-the-scenes details that underscore just how unfit Trump is to the task at hand. It shows that Trump’s refusal to accept the seriousness of coronavirus, and his failure to lay down clear chains of command and elaborate a real long-term plan, created a situation in which officials scrambled to address the crisis almost behind his back.

it’s somewhat heartening that the new NPR poll finds that 44 percent of Americans approve of Trump’s handling of the crisis, while 49 percent disapprove of it.

While 85 percent of Republicans approve, crucially, only 40 percent of independents do, while 50 percent disapprove.

One bit of bad news: 46 percent of Americans say the federal government is doing enough to combat coronavirus, which is obviously not the case, while 44 percent say it is not.

However, 70 percent are concerned that coronavirus will spread to their communities, a massive swing from 44 percent last month, in spite Trump’s efforts to downplay it

Meanwhile, only 37 percent of Americans trust what Trump tells them about coronavirus, while 60 percent do not, and among independents, that’s an even worse 35 percent to 62 percent. Among women it’s a staggering 31 percent to 66 percent.

All this comes as we are confronting very grim new realities. The White House appears to have been jolted by new research out of Britain demonstrating that if the government and individuals do nothing to combat coronavirus’s spread, up to 2.2 million Americans could die.

Conversely, that research also shows that doing what is necessary to seriously curtail such numbers will require sustained, drastic disruptions — and with them, a potentially severe economic downturn.

All this means that in addition to the threat it poses to the country, coronavirus also poses an existential threat to Trump’s presidency. This Trump-protection project will only grow more urgent

Trump and his propagandists have absolute faith in the power of their magical lies to discredit the news media and to substitute their own version of reality for the one the media is reporting. And Trump has kept up the attacks on the press for precisely this purpose.

Early testing, detection, preventionNews that China had reported its first case of the coronavirus was enough reason for South Korean leaders and medical staff to brace themselves for the worst.

Acting fast was the most important decision South Korea made,"

Sites like Corona Map generate real-time updates about where current patients are located and inform proactive Koreans focused on protecting themselves.

By early February, the first test had been approved

"Among Shincheonji members, there were many 20- and 30-year-olds who were infected. Many of them may have never even known they were carrying the virus and recovered easily while silently infecting those around them," Hwang said. "Early testing is why Korea hasn't reached its breaking point yet.

Under South Korea's single-payer health care system, getting tested costs $134. But with a doctor's referral or for those who've made contact with an infected person, testing is free. Even undocumented foreigners are urged to get tested and won't face threats due to their status.

South Korean leaders have amped up efficiency for overwhelmed hospitals by digitally monitoring lower-risk patients under quarantine, as well as keeping close tabs on visiting travelers who are required to enter their symptoms into an app.

Active collaboration among central and regional government officials and medical staff took place before cases began piling up, enabling South Korea's current testing capacity of 20,000 people a day at 633 sites, including drive-thru centers and even phone booths.

That people are willing to forgo privacy rights and allow the publication of sensitive information underlines the willingness to pay the digital cost of state surveillance in the name of public safety,

78.5 percent of respondents agreed that they would sacrifice the protection of their privacy rights to help prevent a national epidemic.

97.6 percent responded that they at least sometimes wear a mask when they are outside, 63.6 percent of whom said they always wear one.

"Wearing masks or self-monitoring alone isn't foolproof to people in Korea, but taking part in these practices as a group is believed to have an impact,"

"This says that your individual choices may not have immediate benefit to you as an individual but will benefit the herd — that it doesn't work unless everybody is in the game."

Despite its apparently swift recovery from the coronavirus, South Korea may only be entering the beginning stages of what experts suspect may be a long ride ahead

bout 80 percent of COVID-19 cases can be categorized as mass infections. A call center in southwestern Seoul was at the center of a local outbreak this month that generated more than 156 infections. About 90 cases were traced to a Zumba class.

local infection clusters are emerging every day in churches, hospitals and other mundane spaces."

outh Korea has already started new testing on all arrivals from Europe, according to local news reports, preparing for a "second wave" of imported clusters. Even those who test negative are required to self-quarantine for 14 days

Some advisers describe an angry Trump as a whistling teapot that needs to either let off steam or explode. Politico has reported on the myriad triggers for his tantrums: “if he’s caught by surprise, if someone criticizes him, or if someone stops him from trying to do something or seeks to control him.”

Like a toddler’s, Trump’s temper has flared repeatedly as the pandemic has worsened and the stock market has tanked.

For Trump’s staff, crisis management revolves around managing the president’s temper, not managing the actual problem.

Anthony Fauci, who’s been running the National Institute of Allergy and Infectious Diseases for decades, responded: “I know, but what do you want me to do? I mean, seriously . . . let’s get real, what do you want me to do?”

Trump’s short, toddler-like attention span has been a problem throughout his administration

During the transition, the Obama administration prepared a tabletop exercise to brief the incoming Trump team about how to handle an influenza pandemic. The president-elect did not participate, and a former senior official acknowledged that “to get the president to be focused on something like this would be quite hard.”

Toddlers are natural contrarians, who love to test boundaries by pushing back on whatever they’re told. So is Trump. In the first two months of the outbreak, he insisted that the coronavirus would never spread within the United States, despite expert assessments to the contrary. In late February, he said: “It’s going to disappear. One day — it’s like a miracle — it will disappear.

Trump, like most toddlers, also has poor impulse control. Some White House advisers reportedly refer to it as the “shiny-object phenomenon” — his tendency to react to breaking news rather than focusing on more important issues.

Much like frazzled preschool teachers, the remaining competent people staffing Trump are clearly past the point of exasperation.

During the coronavirus outbreak, Trump’s access to Twitter has exacerbated his impulsiveness.

Health experts have reportedly tried to get him to focus beyond the immediate bad news cycles of rising infections and look at the larger picture of “flattening the curve” and preventing a much bigger health disaster, to little avail.

One former high-ranking government official told me that a 45-minute meeting with the president was really 45 different one-minute meetings, in which Trump would ask disconnected, rapid-fire questions such as “What do you think of NATO?” and “How big is an aircraft carrier?”

Multiple reports confirm that he has grown restless while confined on the White House grounds. He has crashed staff meetings because he does not know what else to do.

Trump’s inability to sit still has been on display recently

His aides have questioned whether he has the capacity to focus on what will be a months-long emergency.

Each time, Trump’s advisers have had to expend precious time and energy to change his mind and soothe his ego rather than focus on the crisis at hand.

The final and most disturbing parallel between Trump and a toddler is that, like at a day-care center that doesn’t pay caregivers enough, the staff turnover in this administration has hampered the government’s response

Despite expressing his support for the anti-lockdown movement, Trump said on Wednesday that he “strongly” disagrees with Georgia governor Brian Kemp’s decision to reopen bowling alleys, hair salons and other businesses this weekend. Many of the state’s business owners have also concluded it is “way too early” to return to normal.

A tale of two states.

Kentucky

The pandemic has made it almost impossible to register new voters using traditional methods in states across the US. That could have a huge impact on November’s election, writes Sam Levine.

Mainland China reported 55,000 cases of coronavirus in the country’s first wave of infections. But a study by researchers in Hong Kong suggests that number would have been more like 232,000, had the later adopted definition of a Covid-19 case been applied from the outset.

…Mexico, at least 21 doctors and nurses have suffered violent attacks, in public, after being wrongly accused of spreading the disease.

This California town is testing everyone

doctor from Bolinas, California, says her small town north of San Francisco is hoping to become a “model” for the rest of the country, after resolving to test every single member of its community for Covid-19. The town raised $300,000 through GoFundMe to buy testing equipment for its population of 1,600, to help researchers understand how the virus s

cats

Two cats in New York state have tested positive for the virus, apparently after catching it from humans – the first confirmed cases of US pets catching Covid-19.

Catastrophic’ flooding is coming soon. That’s according to new research, which has found that the number of people affected by floods will double to around 147 million annually by the end of the 2020s.

n March of last year, Covid-19 infection and hospitalization numbers started climbing rapidly -- and deaths followed. At least 80% of the country's population was under stay-at-home orders.That was the first of several crushing surges. More than 33 million Americans have been infected with coronavirus, according to Johns Hopkins University, and more than 594,000 have died -- both numbers likely undercounts of the pandemic's true toll.

But now, the US is heading in the right direction, thanks to a powerful ally in the battle against the pandemic: Covid-19 vaccines.

Moderna said Tuesday it's seeking full approval for its vaccine from the US Food and Drug Administration.

Governors nationwide have eased Covid-19 restrictions, and nearly every state that had a mask mandate has now lifted it. But the pandemic certainly isn't over.

We all have more work to do," White House Covid-19 Response Team senior adviser Dr. Marcella Nunez-Smith said recently.

More than 50% of the US population has received at least one Covid-19 vaccine dose, CDC data shows, and more than 40% of the country is fully vaccinated.

Experts say they expect vaccine protection will last much longer than six months, to be confirmed as more data come in.

Both Pfizer and Moderna are also studying their vaccines in children as young as 6 months. Last month, the FDA granted Pfizer's vaccine an emergency use authorization for children 12 to 15.

But in practical terms for the public, there's not a big difference between emergency use authorization and full FDA approval, said Dr. Paul Offit, a member of the FDA's Vaccines and Related Biological Products Advisory Committee.

Both the Moderna and Pfizer vaccines have shown to be extremely safe in both clinical trials and in the real world, he said. Throughout the history of vaccines, he said, any serious side effects have happened within two months after inoculation.

For the first time in more than a year, millions of vaccinated Americans safely enjoyed close holiday gatherings without masks on Memorial Day.

But the majority of Americans still aren't fully vaccinated -- threatening the possibility of yet another post-holiday Covid-19 spike.

Any country that thinks the pandemic is over is wrong, said World Health Organization Director-General Tedros Adhanom Ghebreyesus.

"We're very encouraged that cases and deaths are continuing to decline globally, but it would be a monumental error for any country to think the danger has passed," he said.

The Affordable Care Act provides additional protections, because it requires most health insurers to fully cover all federally recommended preventive care.

Some insurers, including Aetna and certain Blue Cross Blue Shield plans, have already announced that they will not bill patients for the vaccine or its administration.

The federal government has used other levers to curtail surprise vaccine bills. When it offered enhanced Medicaid payment rates this spring, it required states to fully cover coronavirus vaccines for all their enrollees as a condition of receipt. All 50 states accepted the extra funding, and are now subject to those

What makes the vaccine protections unique is that there are requirements on both the insurers and the providers,”

That’s different from the rules around coronavirus treatment, which regulated insurers’ cost sharing but did not take steps to curtail billing by doctors and hospitals. That meant some patients received bills they didn’t expect.

requirements.

Experts also worry about uninsured Americans. The United States does not have a national program to cover vaccination costs for them. For coronavirus, it is instructing health providers to submit costs associated with vaccination to a $175 billion Provider Relief Fund created last spring.

Additional fees could accompany a vaccine. Some providers are accustomed to charging a visit fee for all in-person patients. Most emergency rooms charge “facility fees,” the price of coming in the door and seeking care, as do some hospital-based doctors.

Federal law is quite clear that patients should not have to pay for the vaccine and its administration. But there isn’t language that defines what counts as “vaccine administration,” and whether the visit fee makes the cut.

The question that I’m still not clear on is what happens if someone walks into an outpatient department that charges a facility fee and gets a vaccine,” said Kao-Ping Chua, an assistant professor of pediatrics at the University of Michigan who has studied coronavirus medical billing. “Is there a possibility they could get charged? I think the answer is yes.”

Despite mounting anticipation for the decision, the percentage of parents who will get their young children vaccinated is likely to be low compared to other age groups. A survey from February found that 31% of parents of children in the age range will get their kid vaccinated right away if a vaccine is authorized.

The decision has to come this month “because of the time required for manufacturing the necessary doses,” three of FDA’s top officials – FDA Commissioner Robert Califf, vaccine expert Peter Marks and principal deputy commissioner Janet Woodcock – wrote in a paper published by the journal JAMA in May.Both Pfizer and Moderna are studying vaccines designed to combat omicron and other strains. However, data on the shots remains scarce.

Clinical data from Moderna’s shot is expected this month, according to the company. Moderna in April released findings to support its booster shot development strategy, but the data comes after research in animals suggested the omicron-specific shot might not provide additional protection. A study from scientists at the National Institutes of Allergy and Infectious Diseases’s Vaccine Research Center found that primates boosted with the original vaccine had similar levels of protection as monkeys who got an omicro

The Biden administration has warned of potential fall and winter surges infecting up to 100 million Americans as it gears up for a fall booster shot campaign, whether that is with an omicron-specific shot or not. The FDA authorized a fourth vaccine dose for people ages 50 and older in March, and expanding the shot to more age groups is under consideration.“Administering additional COVID-19 vaccine doses to appropriate individuals this fall around the time of the usual influenza vaccine campaign has the potential to protect susceptible individuals against hospitalization and death, and therefore will be a topic for FDA consideration,” the officials wrote.In fact, the officials said that coronavirus booster shots could be on their way to becoming a yearly occurrence.

It is time to “accept that the presence of SARS-CoV-2, the virus that causes COVID-19, is the new normal,” according to the officials.“It will likely circulate globally for the foreseeable future, taking its place alongside other common respiratory viruses such as influenza,” they wrote.But paying for the shots remains an issue for the Biden administration as Congress shows little appetite for approving more COVID-19 funding.

Facts First: This is partly true. As the experience of Italy and other countries shows, having universal coverage and a government-run health system is not enough on its own to stem the spread of coronavirus. But the US is at a disadvantage in fighting the coronavirus because tens of millions of Americans are uninsured or face high out-of-pocket costs before their insurance kicks in -- which may make people hesitant to seek testing or treatment.

"Addressing coronavirus with tens of millions of people without health insurance or with inadequate insurance will be a uniquely American challenge among developed countries," tweeted Larry Levitt, executive vice president for health policy at Kaiser. "It will take money to treat people and address uncompensated care absorbed by providers."

President Donald Trump has tweeted his support of the package. The Senate is expected to take up the measure when it returns to session this week.

Laboratories in Germany developed tests to detect the coronavirus which the WHO adopted and by last week, the WHO sent out tests to 120 countries. Other countries, like the US and China, chose to develop their own tests, according to the Washington Post.

On February 12, the Center for Disease Control reported that some of the coronavirus test kits shipped to labs across the country were not working as they should.

Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases and one of the experts leading the administration's response to the coronavirus told Congress Thursday that the US was "failing" when it came to getting Americans tested.

In an exchange about how the government bailed out banks during the 2008 financial crisis, Biden asserted that Sanders voted against a bailout for the auto industry.

Facts First: Sanders is right, but this needs context. Sanders voted for a bill that would have bailed out the auto industry -- but it failed to pass the Senate. He voted against a different bailout measure, the $700 billion Troubled Asset Relief Program, or TARP, which passed. That program released money to banks -- and a portion of that money eventually went to automakers.

Facts First: Biden's claim is misleading by omission. Biden was an advocate of ending the Saddam Hussein regime for more than a year before the war began in 2003. While Biden did begin calling his 2002 vote a "mistake" in 2005, he was a public supporter of the war in 2003 and 2004 -- and he made clear in 2002 and 2003, both before and after the war started, that he had known he was voting to authorize a possible war, not only to try to get inspectors into Iraq. It's also unclear whether Bush ever made Biden any kind of promise related to the use of force.

Facts First: The true number of Americans who die because they are uninsured or lack adequate coverage is not known. Some studies suggest the number is in the tens of thousands per year, but other experts have expressed skepticism that the number is as high as Sanders says.

Biden, who was a US senator at the time of his vote, responded, "I learned that I can't take the word of a President when in fact they assured me that they would not use force. Remember the context. The context was the United Nations Security Council was going to vote to insist that we allow inspectors into determining whether or not...they were, in fact, producing nuclear weapons or weapons of mass destruction. They were not."

Sanders on Sunday cited two figures about the number of people he claimed die because of the inadequacy of the US health care system.

During an exchange about Sanders' views on authoritarian countries, Biden claimed that China's income gains have been "marginal."

One way to measure standard of living is through a country's gross domestic product per capita at purchasing power parity. In other words, looking at a country's GDP per person in international dollars, a hypothetical currency used to measure purchasing parity between different countries.

Fact First: This Sanders' claim needs a lot of context. Biden did repeatedly support freezes in Social Security spending and at times called for raising the retirement age. In 2011, he said "changes" would have to be made to entitlements, saying they wouldn't be sustainable -- but he didn't specify what changes. Overall, the claim leaves out that Biden was typically talking about any changes to entitlements in the context of a broader legislative package.

And comments Biden made during a 1995 speech on the Senate floor show he was willing to make cuts to Medicare, but only as part of a broader deal that did not advocate cuts as big as Republicans want.

"If we are serious about saving Social Security, not raising taxes on the middle class, and not cutting back on benefits desperately needed by many senior citizens, we must adjust this artificial ceiling on Social Security taxes and make the Social Security tax more progressive."

Biden said upon his June 2019 reversal that he made "no apologies" for his past support of the amendment. He argued that "times have changed," since, he argued, the right to choose "was not under attack as it is now" from Republicans and since "women's rights and women's health are under assault like we haven't seen in the last 50 years."

Facts First: While it's unclear which ad Sanders was referring to, at least one super PAC connected to Biden, Unite the Country, ran a large television ad campaign that implicitly criticized Sanders without mentioning him by name..

For instance, it includes a clip from a Biden speech, in which Biden says" Democrats want a nominee who's a Democrat" -- an apparent challenge to the party bonafides of Sanders, who serves as an independent in the US Senate and describes himself as a democratic socialist.

As the virus spread, state and local officials ordered residents to stay at home. More than 204 million Americans are living under these unprecedented restrictions, according to a CNN analysis.

At the same time, the US significantly ramped up testing, a key element of the strategy to wipe out the virus. But the US still lags behind other nations in tests conducted per person.

A record number of Americans filed new jobless claims, a reflection of the economic distress created by closures associated with emergency measures to contain the virus. These latest figures from the Labor Department only account for the first week of Trump's two-week plan.

Congress snapped into action and passed two historic bills to deal with the public health crisis and economic meltdown, including a $2 trillion stimulus that Trump signed into law on Friday

Cases have been diagnosed in all 50 states.

And that absence was illustrated just as vividly by news coverage of planes full of medical supplies from China arriving in Italy, at a time when the US was quietly flying in half a million Italian-made diagnostic swabs for use in its own under-equipped health system

“To me what is so striking is the complete absence of the US from public debates. The US is basically off the map, and China very much is on the map,”

what is happening now is going to linger on, simply because what we’re going through now is such a traumatic experience … It is going to remain very much in our individual and collective memories.”

this week’s $2tn stimulus bill contained scarcely more than $1bn (about 0.06%) for spending outside the US.

additional aid has done little to soften the image of an administration that has employed xenophobic rhetoric and breaking with its closest partners in its efforts to intensify economic pressure on its enemies, Iran and Venezuela, whose populations are at high risk from the coronavirus.

Despite its responsibility for allowing the virus to run rampant in the first place, China has had notable success in reshaping its image as a leader by its later efforts to contain the disease and its outreach to Italy and other vulnerable countries.

“China is filling a public goods vacuum, not a leadership vacuum,” Khanna said. “People here are not idiots. They know exactly where this came from, so you don’t need to worry about China winning any global narrative campaign in the world.”

the coronavirus crisis will inflict more lasting damage on the US’s standing than the 2003 Iraq invasion.

“China wasn’t in the wings in 2003,” she said. “It wasn’t ready to take over that global role. Well, it’s now in a position where it can take over global leadership, and it’s just waiting for the US to misstep or to lose support among its allies

From the debacle over testing to Trump’s months-long denial about the scale of the threat and his constant political point-scoring, the US has showed itself to be anything but a model for the rest of the world to emulate.

worldwide faith in US competence has been one of the pillars of its global standing, and is currently crumbling.

“Far from making ‘America great again,’ this epic policy failure will further tarnish the United States’ reputation as a country that knows how to do things effectively,” Walt wrote in Foreign Policy, in a commentary titled “the death of American competence”.

Khanna pointed out that China’s neighbours in Asia are well aware that Beijing’s censorship during the initial outbreak in Wuhan resulted in a missed opportunity to contain the virus

“US global leadership won’t just end because they bungled their response to the coronavirus, but I think we will come to find that this was a pivotal point,”

the extent to which China succeeds in exploiting the crisis to pursue global primacy would be dependent on whether Beijing can be successfully challenged, for example from a change to a more outward leadership in Washington, or a Europe that can transcend its divisions.

“It basically depends on how everyone else reacts more than how China itself acts,”

That was before more than 68,000 people in the United States tested positive for the coronavirus, grinding the country to a halt, upending lives from coast to coast, and postponing primary elections in many states. The virus has made the stakes, and the differing visions the two parties have for health care in America, that much clearer.

“Sometimes these health care debates can get a bit abstract, but when it’s an immediate threat to the health of you and your family, it becomes a lot more real.”

While the Democrats spent much of their primary fighting about whether to push for “Medicare for all” or build on the Affordable Care Act, the coronavirus crisis may streamline the debate to their advantage: At a time when the issue of health care is as pressing as ever, they can present themselves as the party that wants people to have sufficient coverage while arguing that the Republicans do not.

“A crisis like the coronavirus epidemic highlights the stake that everyone has in the care of the sick,” said Paul Starr, a professor of sociology and public affairs at Princeton who served as a health policy adviser in the Clinton White House. “It really strengthens the Democratic case for expanded health coverage, and that should work, I should think, to Biden’s advantage in a campaign against Trump.”

The virus is also having dire economic consequences, depriving Mr. Trump of a potent re-election argument rooted in stock market gains and low unemployment numbers. It is testing Mr. Trump’s leadership in the face of a national emergency like nothing he has encountered, and if voters give him poor marks, that could inflict lasting damage on his chances in November’s general election.

Four years ago, Mr. Trump ran for president promising to repeal the Affordable Care Act, popularly known as Obamacare. But his campaign pledge quickly turned into a debacle in the first year of his presidency when Republicans struggled and ultimately failed to repeal and replace the health law. In the midterm elections the next year, Democrats emphasized health care, highlighting issues like preserving protections for people with pre-existing conditions, and they won control of the House.

Mr. Trump is particularly vulnerable on the issue of health care. Over the course of his presidency, his administration has repeatedly taken steps to undermine the Affordable Care Act, including by arguing in court that the entire law should be invalidated. The Supreme Court agreed this month to hear an appeal in that case, which is the latest major challenge to the law. The court is not expected to rule until next year, but Democrats point to the Trump administration’s legal position as yet another example of the president’s desire to shred the Affordable Care Act.

In his campaign, Mr. Biden has already put a focus on health care, promising to build on the Affordable Care Act and create a so-called public option, an optional government plan that consumers could purchase. On the campaign trail, he has talked about his own exposure to the health care system

In the Democratic primary race, the health care debate has largely focused on the divide between moderate-leaning Democrats looking to build on the Affordable Care Act and progressives calling for Medicare for all, a government-run health insurance program. Mr. Biden and Mr. Sanders represent the two sides of that argument.

In a poll this month by Morning Consult, four in 10 Americans said the coronavirus outbreak had made them more likely to support universal health care proposals in which everyone would receive their health insurance from the government.

Multiple times throughout Friday's press briefing, the President claimed the current situation was unprecedented and unforeseen. According to Trump, "nobody was prepared for this," not even past presidents. He added, "In all fairness to all of the former presidents, none of them ever thought a thing like this could happen."

This is false. The US intelligence community and public health experts had warned for years that the country was at risk from a pandemic. Experts had also warned that the country would face shortages of critical medical equipment, such as ventilators, if a pandemic occurred.

Trump said of the coronavirus: "You can call it a germ, you can call it a flu, you can call it a virus, you know you can call it many different names. I'm not sure anybody even knows what it is."

You cannot accurately call the coronavirus "a flu." They are, simply, different viruses with different characteristics, though they share some symptoms the coronavirus has a much higher mortality rate.

it's significantly more serious" -- with a mortality rate approximately 10 times higher than the 0.1% for the flu. It's also obviously untrue that there is not "anybody" who knows what the coronavirus is.

The most revealing false claim: The flu mortality rate

VirusesAwareness of Ebola in 2014Comparing the coronavirus outbreak with the Ebola situation of 2014, Trump said, "At that time, nobody had ever even heard of Ebola." -- February 25 press conference in New Delhi, India "Nobody knew anything about it. Nobody had ever heard of anything like this." -- February 26 coronavirus press conference Facts First: Some Americans certainly didn't know a whole lot about Ebola before 2014, but the claims that "nobody" had ever even heard of Ebola and that "nobody" knew anything about it are absurd. Ebola was discovered in 1976. It had been the subject of considerable media coverage in the next three decades, not to mention scientific study.

Gupta, CNN chief medical correspondent, told Trump at a press conference, "Mr. President, you talked about the flu and then in comparison to the coronavirus. The flu has a fatality ratio of about 0.1%." Trump said, "Correct." But Trump later disputed the figure, saying, "And the flu is higher than that. The flu is much higher than that." -- February 26 coronavirus press conferenceFacts First: Even if Trump meant that the flu has a "much higher" fatality rate than 0.1% -- rather than meaning that the flu's mortality rate is "much higher" than that of the novel coronavirus -- he was wrong. The mortality rate for seasonal flu is "about 0.1%, 0.2% at the most," Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health -- who appeared with Trump at this same news conference -- told this to USA Today in mid-February, echoing the comments of other experts and Centers for Disease Control and Prevention data since 2010.

Even as nations from Britain to India declare nationwide economic lockdowns, President Trump said he “would love to have the country opened up, and just raring to go, by Easter,” less than three weeks away, a goal that top health professionals have called far too quick.

he expressed outrage about having to “close the country” to curb the spread of the coronavirus and indicated that his guidelines on business shutdowns and social distancing would soon be lifted.

“I gave it two weeks,” he said, adding, “We can socially distance ourselves and go to work.”

“We are honored to serve and put our lives on the front line to protect and save as many lives as possible,” the American Medical Association, American Hospital Association and American Nurses Association wrote in an open letter. “But we need your help.”

Mr. Trump fell back on his comparison of the coronavirus to the flu, saying that despite losing thousands of people to the flu, “We don’t turn the country off.”

States including California, Maryland, Illinois and Washington have declared stay-at-home or shutdown orders, but other states have been looking for directives from the Trump administration. And countries in Asia are beginning to see a resurgence of coronavirus after easing up on restrictions.

For governors and mayors who have been trying to educate people about the urgent need to stay home and maintain social distance, Mr. Trump’s recent statements suggesting that such measures may be going too far threatened to make their jobs more difficult.

Mr. Hogan, the chairman of the bipartisan National Governors Association, said that health officials suggest that the virus’s peak could be weeks or months away. “We’re just trying to take the best advice that we can from the scientists and all the experts, and making the decisions that we believe are necessary for our states,” he said.

Both Mr. Trump and Vice President Mike Pence said that a lockdown had never been under consideration for the United States.

But the president and vice president were resolute that they want the country reopened. Mr. Pence said the administration’s timeline for trying to get businesses restarted and workers out of their homes was shorter than the period that health experts have said would be necessary to flatten the curve.

“We’ll focus on our most vulnerable, but putting America back to work will also be a priority, in weeks not months,” Mr. Pence said.

Mr. Pence also said two malaria drugs, chloroquine and hydroxychloroquine, had been approved by the Food and Drug Administration for off-label use treating patients with Covid-19, the disease caused by the coronavirus. The F.D.A. did not immediately confirm that assertion, but two administration health officials said it was not true.

India, the world’s second-most populous country, will order its 1.3 billion people to stay inside their homes for three weeks to try to curb the spread of the coronavirus, Prime Minister Narendra Modi declared on Tuesday.

Left unclear was how Indians would be able to get food and other needed supplies. Mr. Modi alluded vaguely to the government and civil society groups stepping in to help, but offered no details.

Mr. Modi also pledged to spend about $2 billion on medical supplies, isolation rooms, ventilators, intensive care units and training for medical personnel to combat the pandemic.

New York’s case count is doubling every three days, the governor says.

“We haven’t flattened the curve,” he said. “And the curve is actually increasing.” The governor, appearing in front of piles of medical supplies, spoke in a far more sober tone and delivered notably bleaker news than he has in previous days.The peak of infection in New York could come as soon as two to three weeks, far earlier than previously anticipated, Mr. Cuomo said, which would put even bigger strain on the health care system than officials had feared.

The governor said the state now projects that it may need as many as 140,000 hospital beds to house virus patients, up from the 110,000 projected a few days ago. As of now, only 53,000 are available. Up to 40,000 intensive-care beds could be needed. “Those are troubling and astronomical numbers,” he said.

In New York City alone, there have been around 15,000 cases.“Look at us today,” he warned the rest of the country. “Where we are today, you will be in four weeks or five weeks or six weeks. We are your future.”

Perhaps it was inevitable that New York City and surrounding suburbs would become the epicenter of the coronavirus epidemic in the United States. The population density, reliance on public transportation and constant influx of tourists — all would seem to make the metropolitan area a target.

But to stop the virus, scientists have to figure out which factors played a greater role than others. As it turns out, that is not so simple.

Perhaps the epidemic in New York had less to do with the virus than with discrete opportunities to spread: In so-called super-spreader events, one patient somehow manages to infect dozens, even scores of others. At one point, half the cases in Massachusetts were attributed to a single initial infection.

A second expert agreed broadly. Dr. Arnold Monto, a professor of epidemiology at the University of Michigan School of Public Health, said by email: "I agree that by 3 weeks, we will have a better idea of what is going to happen going forward. The outbreaks seem to be hitting different communities at different times and at different intensities, so it is hard to generalize However, I agree in general. And that is why action now in terms of social distancing is so important."

Dr. William Schaffner, an infectious disease specialist at Vanderbilt University, said the peak might take three more weeks.

He said he was more skeptical about the United States being able to lift restrictions on only part of the population. "Asking a subset to remain sheltered in place, to remain in home, that's more difficult to do," he said by phone.

One disease modeler said it was "impossible to predict" when the peak would hit. Dr. Stefan Flasche, a disease modeler at The London School of Hygiene & Tropical Medicine, told CNN by email the peak was influenced by the efficiency of lockdown measures, and "may be anywhere between some time very soon and not for another few months."

President Donald Trump has said his desire to lift measures as quickly as possible is motivated by a desire to get the American economy moving again. He has expressed a belief that the economy could experience a "v" shaped, ultra-fast recovery. Yet one economist expressed doubt recovery could be that fast-paced and warned that snapping back in and out of restrictions could cause greater damage.

Erin Strumpf, a professor of economics at McGill University, told CNN: "Nothing suggests that we could just 'snap back' to life as it was before. We're taking concrete actions to lower the probability of an uncertain outcome."

What’s happening here, in this country, was avoidable. Nearly every flaw in America’s response to the virus has one source: America did not test enough people for COVID-19.

If there is one thing about the novel coronavirus that you must understand, it’s that it is a firecracker with a long fuse. Here is what the explosion looks like: Every six days, the number of people infected by the disease doubles

Every six days that the country did not test, every six days that it did not act, the number of infected Americans doubled.

“If you don’t know where the disease is early in the epidemic, you have no hope of containing it,” Bhadelia said. “Even now, [testing is] that Achilles’ heel; it’s the crack that is making its way throughout our entire response.”

Testing should have answered the all-important question in any pandemic: How many people are sick right now? Had the nation known that, the systems that were put into place over years of pandemic planning could have powered on, protecting millions of Americans and containing the illness.

An invisible fuse sets off this burst of disease. If someone is infected with the coronavirus on Monday, she may start being contagious and infecting other people by Wednesday. But she may not start showing symptoms until Friday—meaning that she was spreading the virus before she even knew she had it. And in some cases, infected people take 14 days to start showing symptoms.

the CDC hit a disastrous roadblock, as it began to send test kits to public-health labs across the country. Two of the test’s reagents were fine, in most cases, but a third chemical initially deemed necessary for the test simply did not work. For the time being, every test for COVID-19 would have to be conducted by the CDC.As the CDC struggled to find a solution, other laboratories tried to bring their own tests online. They found themselves hamstrung by the FDA, which, though it repeatedly loosened the rules, could not move as fast as the coronavirus.

No one at the federal level was moving fast enough to actually deal with the looming disaster.

On February 26, the CDC confirmed what should have been clear much earlier: Community transmission in the United States had begun. The coronavirus was now spreading among Americans who had not traveled abroad or known a confirmed case. At least 60 people in the country now had the virus, according to the CDC’s totals at the time—and, as researchers and analysts soon realized, the true number was almost certainly much higher.

By the end of February, the disease had not only established itself in the United States. It had been circulating for close to six weeks. Seattle, on March 1, found itself in the same position as Wuhan did on January 1, with a growing coronavirus outbreak that was on the verge of exploding.

February was our chance to get this right. We lost that entire month. And we now live in a new era of work stoppages, overwhelmed hospitals, dead elders, and a wrecked economy.

Several of my colleagues and students and I have statistically analyzed thousands of seasonal coronavirus cases in the United States and used a mathematical model to infer that immunity over a year or so is likely for the two seasonal coronaviruses most closely related to SARS-CoV-2 — an indication perhaps of how immunity to SARS-CoV-2 itself might also behave.

An alternative possibility, which many scientists think is more likely, is that these patients had a false negative test in the middle of an ongoing infection, or that the infection had temporarily subsided and then re-emerged

the issue might be resolved by comparing the viral genome sequence from the first and the second periods of infection.

it is reasonable to assume that only a minority of the world’s population is immune to SARS-CoV-2, even in hard-hit areas. How could this tentative picture evolve as better data come in? Early hints suggest that it could change in either direction.

One recent study (not yet peer-reviewed) suggests that rather than, say, 10 times the number of detected cases, the United States may really have more like 100, or even 1,000, times the official number

if this one is correct, then herd immunity to SARS-CoV-2 could be building faster than the commonly reported figures suggest.

another recent study (also not yet peer-reviewed) suggests that not every case of infection may be contributing to herd immunity. Of 175 Chinese patients with mild symptoms of Covid-19, 70 percent developed strong antibody responses, but about 25 percent developed a low response and about 5 percent developed no detectable response at all

Mild illness, in other words, might not always build up protection. Similarly, it will be important to study the immune responses of people with asymptomatic cases of SARS-CoV-2 infection to determine whether symptoms, and their severity, predict whether a person becomes immune.

The balance between these uncertainties will become clearer when more serologic surveys, or blood tests for antibodies, are conducted on large numbers of people. Such studies are beginning and should show results soon. Of course, much will depend on how sensitive and specific the various tests are: how well they spot SARS-CoV-2 antibodies when those are present and if they can avoid spurious signals from antibodies to related viruses.

Based on the volunteer experiments with seasonal coronaviruses and the antibody-persistence studies for SARS and MERS, one might expect a strong immune response to SARS-CoV-2 to protect completely against reinfection and a weaker one to protect against severe infection and so still slow the virus’s spread.

But designing valid epidemiologic studies to figure all of this out is not easy — many scientists, including several teams of which I’m a part — are working on the issue right now.

getting a handle on this fast is extremely important: not only to estimate the extent of herd immunity, but also to figure out whether some people can re-enter society safely, without becoming infected again or serving as a vector, and spreading the virus to others. Central to this effort will be figuring out how long protection lasts.

Experimental and statistical evidence suggests that infection with one coronavirus can offer some degree of immunity against distinct but related coronaviruses.

then there is the question of immune enhancement: Through a variety of mechanisms, immunity to a coronavirus can in some instances exacerbate an infection rather than prevent or mitigate it.

administering a vaccine against dengue fever, a flavivirus infection, can sometimes make the disease worse.

concern that they might be at play is one of the obstacles that have slowed the development of experimental vaccines against SARS and MERS.

The good news is that research on SARS and MERS has begun to clarify how enhancement works, suggesting ways around it, and an extraordinary range of efforts is underway to find a vaccine for Covid-19, using multiple approaches.